Missing Americans: Early death in the United States—1933–2021

Author:

Bor Jacob1ORCID,Stokes Andrew C1ORCID,Raifman Julia2,Venkataramani Atheendar34ORCID,Bassett Mary T5,Himmelstein David67ORCID,Woolhandler Steffie67ORCID

Affiliation:

1. Department of Global Health, Boston University School of Public Health, 801 Massachusetts Avenue, Boston, MA 02118 , USA

2. Department of Health Law, Policy, and Management, Boston University School of Public Health, 715 Albany Street, Boston, MA 02118 , USA

3. Leonard Davis Institute for Health Economics, University of Pennsylvania, 3641 Locust Walk, Philadelphia, PA 19104 , USA

4. Medical Ethics and Health Policy, University of Pennsylvania, 423 Guardian Drive, Philadelphia, PA 19104 , USA

5. François-Xavier Bagnoud (FXB) Center for Health and Human Rights, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA 02115 , USA

6. Hunter College, City University of New York, 695 Park Avenue New York, NY 10065 , USA

7. Cambridge Health Alliance, Harvard Medical School, 1493 Cambridge Street, Cambridge, MA 02139 , USA

Abstract

AbstractWe assessed how many US deaths would have been averted each year, 1933–2021, if US age-specific mortality rates had equaled the average of 21 other wealthy nations. We refer to these excess US deaths as “missing Americans.” The United States had lower mortality rates than peer countries in the 1930s–1950s and similar mortality in the 1960s and 1970s. Beginning in the 1980s, however, the United States began experiencing a steady increase in the number of missing Americans, reaching 622,534 in 2019 alone. Excess US deaths surged during the COVID-19 pandemic, reaching 1,009,467 in 2020 and 1,090,103 in 2021. Excess US mortality was particularly pronounced for persons under 65 years. In 2020 and 2021, half of all US deaths under 65 years and 90% of the increase in under-65 mortality from 2019 to 2021 would have been avoided if the United States had the mortality rates of its peers. In 2021, there were 26.4 million years of life lost due to excess US mortality relative to peer nations, and 49% of all missing Americans died before age 65. Black and Native Americans made up a disproportionate share of excess US deaths, although the majority of missing Americans were White.

Publisher

Oxford University Press (OUP)

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